AB0673 OVARIAN RESERVE IN SYSTEMIC SCLEROSIS, SYSTEMIC LUPUS ERYTHEMATOSUS AND BEHCET’S DISEASE
Authors: R. Goloeva, Z. Alekberova, M. Cherkasova, O. Koneva, L. Garzanova, A. Lila
Journal: Annals of the Rheumatic Diseases (2022)

Background Anti-Mullerian hormone (AMH) is one of the key parameters for assessing reproductive function and ovarian reserve. The levels of AMH correlates with the residual follicular pool in women of reproductive age. Objectives To assess AMH levels in female patients of child-bearing potential with systemic sclerosis (SSc), systemic lupus erythematosus (SLE) and Behcet’s disease (BD), and analyze the relationship between AMH levels and disease severity, as well as relationship between serum AMH levels and different therapeutic regimens. Methods The study group included 48 women with SSc, 47 with SLE 45 with BD aged 20-40 years, and the control group included 15 age-matched healthy women. SSc pts’ mean age was 32,9 [28;37] years, SLE pts’ 32,3 [29;36] years, BD pts‘ 31,3 [27;35] years, disease duration was 6,3 [3;10], 9,8 [3;16] and 6,0 [3;8] years respectively. AMH levels was measured using ELISA. AMH reference values ranged within 1.0-10.6 ng / ml. Values &lt;1.0 were interpreted as a decreased ovarian reserve. Results Mean AMH levels were 3.4 ng/ml in SLE pts, 2.5 ng/ml in BD pts and 3.1 ng/ml in controls, showing no statistical difference. However, in patients with SSc mean AMH was significantly lower compared to control (2.2 ng/ml vs. 3.1 ng/ml, p=0,03). Table 1. AMH in patients and control group form SSc, n=48 SLE, n=47 BD, n= 45 Controls,n=15 p Mean AMH 2,2[0,29-3,06]* 3,4[0,64-5,4] 2,5[1,1;3,7] 3,1[1,9;4,9]* 0,03 AMH &gt;1 ng /ml,n(%) 21 (43,7)* 13 (27,7) 8 (17,7) 2 (13,3)* 0,03 A redaction of ovarian reserve (AMH less than 1.0 ng / ml) was more often observed in SSc pts compared to controls (44% vs 13%), p=0,03. The mean AMH levels were significantly lower in pts with SSc receiving cyclophosphamide (CYC). Correlation analysis revealed a negative correlation between levels AMH and CYC therapy (r=-0.33, p&lt;0.05), with erythrocyte sedimentation rate (r=-0.36), heart involvement (r=-0.32) and gastrointestinal involvement (r=-0.31), digital ulcers (r=-0.33) and digital pitting scars (r=-0.28). Correlation with other clinical manifestations, immunological markers and immunosuppressive therapy of SSc wasn’t found. In five patients receiving CYC earlier, the level of AMH was within normal values, the total dose of CYC at them did not exceed 4g. No correlation was found between AMH and activity SLE (SLEDAI 2K), disease duration, and clinical course. Correlation analysis of levels AMH and SLE therapy revealed a negative correlation between AMH and CYC therapy (r=-0.32, p&lt;0.05), a positive correlation with hydroxychloroquine therapy (r=0.34, p&lt;0.05). Correlations of AMH with the clinical picture of SLE and therapy with other immunosuppressive drugs have not been obtained. In patients with SLE, previously or currently received CYC, a significant decrease in average AMH was revealed 2,4 [0,4-4,3] vs 4,2 [1,3;5,7], and they also significantly more often had a low levels of AMH (&lt;1 ng/ml), 47,4% vs 14,3% pts, p&lt;0.05. In three patients who had received CYC earlier, the level of AMH was within normal values, the total dose of CYC did not exceed 5.6 g. When analyzing the levels of AMH with the clinical picture and BD therapy, no correlations were found. Conclusion Mean levels AMH and ovarian reduction of reserve was significantly lower in women with SSc pts compared to healthy controls. The levels of AMH negatively correlated in SSc pts with CYC therapy, erythrocyte sedimentation rate, heart damage and gastrointestinal tract involvement, digital ulcers and digital scars. The levels of AMH negatively correlated in SLE pts with CYC therapy. CYC therapy negatively affected ovarian function, and most likely in a dose-dependent manner. Behcet’s disease does not seem to have much effect on the ovarian reserve. Disclosure of Interests None declared